器官移植的发展与未来

器官移植的發展與未來台北榮總一般外科龍藉泉Humanchimera,or“homonovo.”Man’soriginalstructurehasbeenmodifiedsothathecanacceptanorgan“fromelsewhere”MythandLegendMythandLegendMythandLegendMythandLegendProf.V.Demikhovandhistwo-headeddog.phototakentwodaysaftertheoperationU.S.S.R(1950)MAINSTEPSINGRAFTHISTORYTHEPLANTGRAFT:VERYEARLYINMAN’SHISTORYTHEANIMALGRAFT:18THCENTRURYTHEHUMANGRAFT:18THCENTURYORGANTRANSPLANTATION:20THCENTURYFROMGARDENTOFARMYARDFROMGARDENTOFARMYARD19THCENTURY:ALLFROMSOFGRAFTSBoronio’ssheep(1804).Successfulreplacementskingraftsonthebackofanewe.PaulBertnexttoClaudeBernard,performingavivisectionprocedureinhislaboratoryattheCollegeofFrancein1889.Freesplit-skingraftonaburnoftheshoulderandarm.THEKIDNEY:APILOTORGANTHEFIRSTTRANSPLANTATIONINANIMALAttheViennaMedicalSocietymeetingheldinJanuary1902,thesurgeonEmerichUllmannreportedthefirstcaseofrenaltransplantationperformedintheneckofadog.Theureter,broughtouttotheskin,oozeda“liquidwhichresembleurine”overaperiodoffivedays.Dr.AlexisCarrel–AmagicianFirstrenaltransplantationsinman:1906-1913In1906,MathieuJaboulayperformedrenaltransplantationinman.Hetransplantedtheleftkidneyofapig,killed3hourspreviously,intotheleftelbowofawomansufferingfromnephroticsyndrome.Thegraftremovedonthethirddayandthevesselswerefoundtobeobstructedbyclots..Firsttransplantationbetweenhumans:1933In1933,therussiansurgeonVoronoy(1896-1961)performedthefirsthomologousrenaltransplantationinmanusingahumancadaverkidney.SergeVoronoff,attheCollègedeFrance.Testiculartransplantationfromamonkeytoman.Aretiredindianarmycolonelinfineformaftertheoperation.TheBrighamcommando:1947Ayoungwomanwasinprofoundcomawithanuriafor10daysfollowinganabortioncomplicatedbyacutetubulopathyduetosepticshockandincompatibletransfusion.DavidM.Hume(1917-1973)Paris,Christmas1952:thepresentfromamothertohersonMrsRenardandhersonMariustowhomshedonatedakidneyinDecember1952.Pelvicimplantationofthekidneywithrestorationoftheurinarytract.ArealSuccess:1954JohnMerrillandJosephMurry(NobelPrize1991)attheBrighamin1953Firstsusccessfultransplantationbetweentwoidenticaltwinsin1954bytheMurry,MerrillandHarrisonteam.PeterBrianMedawar,NobelPrizein1960.Rejectionwasbytheactionoflymphocyteswhichdescribedas“immunocomeptentcells“MAJORHISTOCOMPATIBILITYCOMPLEX:1952(JeanDausset,NobelPrizein1980)(HumanMHC)Immunosuppression:TotalBodyIrradiation“Sam”and“HonestJohn”FirstprolongedsurvivalofrenaltransplantationwithanunrelateddonorMrsGenandherdonoratFochHospitalin1960DevelopmentofImmunosuppressiveDrugsMarianneMattlaerwith“Mana”,whoreceivedakidneyin1960withimmunosuppressionbyazathioprine,withalittertowyearsafterthetransplantation.AdventofCyclosporineTheprimitivefungusfromwhichcyclosporineisextracted(Tolypocladiuminflatum)SirRoyCalneProgressinHemodialysisWilliamJ.Kolff,fatheroftheartificialkidneyandheart.ThefirstartificialkidneydesignedbyKolffin1945.TissueTyping“Thecentreeffect”:TerasakiandstatisticsOrganPreservationFalkertO.Belzer.ThefirsthumankidneypreservedonaperfusionmachinepriortotransplantationinAugust1967.OrganPreservationLiverTransplantationThomasStarzlintheoperatingroomonMarch1,1963,performedthefirstlivertransplantation,therecipientsurvivedfivehoursafterthetransplantation.OilpaintingbySirRoyCalne(1990)representaphaseoflivertransplantationcoordinatedbytheentiresurgicalteam.PancreasandIntestinalTransplantationRichardLilleheiHeartandLungTransplantationDeniseDarvall,thefirsthumanheart”donor”LouisWashkansky,theheartrecipient.December3,1967.ChristiaanN.Barnard,cardiovascularsurgeonatCapetown.ArtificialHeartHeartandLungTransplantationJamesD.Hardy’steam,performedthefirsthumanlungtransplantationonJune11,1963,sevenandahalfmonthsbeforetheyperformedthefirsthumanheterologushearttransplantation.XenotransplantationThefirstbloodtransfusionfromanimalstomanwereattemptedin1628.Xenotransplantation器官移植在臺灣的發展腎臟1968.05.27台大李俊仁自體骨髓1983.11.09台大陳耀昌異體骨髓1984.03.09台大陳耀昌肝臟1984.03.22長庚陳肇隆胰臟1984.04.01長庚陳肇隆心臟1987.07.17台大朱樹勳肺臟1991.07.10北榮王良順台灣器官移植之父台灣肺臟移植的先驅王良順教授，台北榮總呼吸加護病房主任Howthetransplantationisdoing?Howthetransplantationisdoing?SPKTFromDonortoRecipientFrom8AMto2AM09/20/2003LiverandPancreasinBackTableY-graftReconstructionSMASAEIAIIACIAPancreasTransplantationCold/WarmIschemicTime=452min/38minPVDuodenumgraftY-grafta.PancreasgraftDuodeno-jejunostomyinSPKTPancreasSPKTon09/19/2003Pancreatico-DuodenalgraftKidneygraftJejunumFirst24hoursBloodSugarafterSPKTFirstMonthBloodSugarafterSPKTRenalFunctionafterSPKTSPKTHappyDischargeon10/09/2003Wherearewegoingto?ImmuneToleranceXenograftStemCellArtificialOrganImmuneToleranceImmuneToleranceStemCellsStemCellsArtificialOrganXenotransplantation美麗新世界的來臨總是需要更多的心去參與